Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period. The complex foods consumed are broken down into small molecules of glucose, which is used by the cells of the body as a fuel for its function. In Diabetes, due to the reduction of insulin production or increased insulin resistance, glucose cannot be transported across the cell membranes for its use as an energy source, hence excessive glucose accumulates in the blood. 

Symptoms of high blood sugar include frequent urination, increased thirst and increased hunger. If left untreated, diabetes can cause many complications. Among the various systemic complications, periodontal disease (disease of the gums) is the 6th major complication. Although known since 1993, there is very little awareness on the oral complications of diabetes. 

Common oral problems encountered in diabetics- 

1. Periodontal diseases (periodontitis and gingivitis)- Diabetes affects the tissue composition of the gums, by altering the collagen metabolism in the mucosa and gingiva (gums). Increased blood glucose impairs the normal host defense mechanism by reducing the function of neutrophils (first line defense cells of the body) as well as increases the count of pathogenic bacteria due to increased glucose concentration in the crevicular fluid. Hence, diabetics commonly encounter infection and inflammation of the gums, which is noted as bleeding from gums, swollen and enlarged gums, pus discharge and abscess, loose teeth, pocket formation and oral malodour.

2. Dry mouth- Diabetics commonly suffer from decreased salivation resulting in dryness of mouth, cracks and fissures on the tongue and corner of the mouth (angular cheilitis).

3. Tooth decay- It is frequently encountered in diabetics due to the increased pathogenic bacteria and decreased salivation.

4. Burning sensation in the mouth and generalized redness of the oral mucosa.

Diabetics are 3-4 times more prone to periodontal disease as compared to healthy individuals. In addition, individuals with poorly controlled diabetes experience faster progression of periodontal disease and more severe symptoms. Diabetics with poor oral hygiene are at a higher risk of developing periodontal disease as compared to diabetics with a good oral hygiene maintenance. 

It has been observed that many individuals who have been unaware about their diabetic status have got diagnosed with diabetes incidentally during dental examinations. 

What effect does periodontal disease have on diabetes?

The effect of diabetes on oral & periodontal disease has been well-documented but the reverse relationship has been more recently understood. It has been well-understood that any acute bacterial or viral infection affecting the body results in temporary insulin resistance and increased blood glucose. 

Periodontal disease is a low grade chronic inflammation. This chronic inflammation results in elevated levels of inflammatory cytokines which affects the insulin secretion and results in insulin resistance. Studies have shown that treatment of periodontal disease reduces the levels of circulating inflammatory cytokines in blood and insulin resistance. A simple cleaning (scaling) of teeth has shown a reduction in the HbA1c levels by 0.4% and combined therapy with antimicrobials has shown a reduction by 0.7%. Individuals having poorly controlled diabetes have shown a higher reduction in blood glucose levels post periodontal treatment. 

So, what do we understand from the current data?

1. Diabetics are at a greater risk of oral diseases, especially poorly controlled diabetes. 

2. Diabetes with poor oral hygiene increases the risk of gum diseases many fold.

3. Poor gum health or untreated periodontal disease can worsen diabetes. 

What should be our action plan?

1. Diabetics should visit a dentist (preferably a Periodontist) for regular check-ups and should treat any dental infection promptly. 

2. Brushing twice daily and maintain good oral hygiene.

3. Use of a mouthwash for the management of dry mouth.

4. Eat a healthy diet, exercise and maintain a regular record of the blood glucose.